Managing Employee Wellness using Occupational Health Surveillance


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Employee wellness is a hot topic at many organizations but it can be difficult to define the role occupational health practitioners should play, particularly when it comes to non-occupational factors.

In this free webinar, Medgate experts will explore how occupational health teams can play a pivotal role in employee wellness. They’ll identify why health surveillance is important, what factors should be monitored, and how to set your program up for success.

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  • I’m going to talk about the expanded use of health surveillance in the occupational health settingOccupational health nurses are in a unique position to aid employees in optimizing their health and wellness by providing non occupational education and counseling at the workplace. Health screening, medication education and chronic disease management are all surveillance activities that can be done in the workplace whether the facility provides primary care or not.
  • Ok, now that you’ve completed the poll, let’s move on to talking about how to address some of these challenges you may have. We’ll discuss why implementing a non occupational health surveillance program can be a very beneficial activity for your organization.
  • Thanks Mike--Good morning first of all I would like to introduce myselfI’m Sue NaylorGot my start in emergency medicine, where worked for 11 yrsI spent the next 30 years in occupational health with a large manufacturing companyMy credentials include Family Nurse practitioner and Certified Occupational health nurse. I assisted in primary care and developed the primary care service program at my companyWe used Medgate’s OH&S software at my company and I had a good relationship with the company and the product, so after I retired I joined the medical product team and have been contributing to the development of the applicationI stillwork as a nurse practitioner in an internal medicine office (you can’t stop me!)My passion is aiding patients in optimizing their health, and to accomplish this, I feel that all healthcare team members need to participate in their care.
  • By ‘workplace health promotion programs’, means programs that serve to prevent and mitigate diseases. Workplace health promotion is a concern that will only continue to grow for organizations as health care costs soar. The study offers a realistic and educated view of potential savings - 18%, not the higher numbers we may be accustomed to seeing but it’s enough to build a compelling business case for decision-makersEmphasizes that implementing health surveillance is particularly impactful when it comes to the older working-age population, age 45+ as potential annual savings are 9.0 times greater for the older age groupIt’s an interesting article and if you have a subscription, I would recommend you take a readLet’s look at some additional facts & figures to support the implementation of health surveillance [transition to next slide]
  • Let’s look at obesity, one of the largest health crises facing the U.S., according to the CDC. It costs employers every day. Precursor to many other diseasesImpacts happiness, productivity, and presenteeismLet’s look at how trend is developing, and rapidly
  •  You can start to see some change within the 10 years from 1990 to 2000
  • The change from 1990 and even 2000 to 2010 is dramatic. There’s a role for occupational health to get involved and work with employees Work with HR team and HRAs for integrated approach to support a healthy employee
  • Same with heart disease. According to Healthy People 2020-Read slideObesity is one of the precursors to heart disease, as is poor diet and lifestyle choices. However, what I want to stress is that heart disease and stroke are among the most preventable diseases. This is where we as occupational health practitioners have the opportunity to truly make a difference.
  • Again from Healthy people 2020Read slide
  • Read slide There may be concerns that running non-occupational surveillance is time intensive and expensive, but the fact is that you will be saving the organization money in the long runWe’ll talk later on about how you don’t need to reinvent the wheel to expand your current programs, so it doesn’t have to take a lot of extra time, staff, and money
  • To further support the ROI of occupational health involvement in health promotion, consider the cycle of health & productivity[go through each of the stages].
  • What is the objective of incorporating non occupational health surveillance (and possibly also primary care) into the occupational health setting?To add value to the organization- This pyramid shows the Value of non occupational health surveillance and/or primary care in the occ health setting Disease Prevention is by far the most effective way to prevent health care costs and bring value to your organization. Health education and lifestyle health coaching play a large role in prevention. Early detection is the next way to help save money and help the employee by preventing poor outcomes. Medical screening is a good tool for early detection. Managing and treating chronic disease is the final way to manage costs and help the employees maintain the best quality of life possible given their disease process.
  • Ok, so we’ve talked about WHY health promotion programs are important, and you’ve completed the poll and are thinking about the level of involvement the occupational health team has in health promotion at your organization. We’ll hopefully be able to come back to the poll results at the end but most of you probably don’t have a fully developed program, that’s why you’re here. Even if you do have a fully developed program, you can always improve it. With that in mind, let’s now think about what happens once you have the buy in for your program and are putting it in place. What, then is the role the occupational health practitioner and team should take? [go through each one]
  • When you’re building out your program, there are a number of factors that you can incorporate into your health surveillance program. I’ve broken them down into three categories.
  • read
  • You can use the standard medical screening tests to help remind your patients of what tests would be due based on their age, gender and family history or for their specific condition
  • Here’s a list of resources – you will get this in your copy of the slides after the presententation
  • Here are some more ideas and options for setting up surveillance and the related exposure groups[say with 1st point] – exposure group could be called ‘medical screening’ – based on employee’s demographics,[2nd point] You can set up exposure groups for each risk area, and then allow the employee to self-select[3rd point] You can choose whether you want to review screenings during a scheduled occupational surveillance activitiy or set up scheduled times for the employee to come in specifically for the non-occupational medical screening. Or you could do both - for example, if the practitioner is meeting with an employee for an occupational visit, then he or she would see the medical screening activities that are due for that employee and can then take action on completing the activity, whether it be ordering a test if your practitioners do that, or whether it is simply providing counseling. Chrissy will speak specifically to setting up surveillance groups so I won’t get into more detail
  • Here’s a slide that was given in the Medgate User Group conference keynote presentation this year, given by Dr. Arthur Brown of Memorial Sloan Kettering Cancer Center, If you look at Memorial Sloan Kettering’s diagram here, you can see that 8% of the population has the highest health care expenditures while 33% are in the middle and need to start some risk reduction measures so they don’t get to the high risk group and 53 % just need to maintain health.By using Occupational health surveillance tools for non occupational health services--we can affect all 3 of these groups.
  • Diabetic patients may not be aware of the potential for complications from uncontrolled Diabetes. These patients are on multiple medications, need close follow up and are required to have many tests . If they do not understand the importance they may skip their annual eye exam or their foot exam to detect early peripheral neuropathy. Reminders of what tests and how often they need them could also be part of surveillance activities. Education is a large part of Diabetes management. Occupational health nurses are well positioned to provide health education to employees . You already have a relationship with them so they would likely be willing to work with you to help them manage their care , set their treatment goals and celebrate their successes
  • [DON’t Read Points 1 & 2, just say the following:] You would build your chronic disease surveillance much like you would your medical screening. Just set up exposure groups for the various diseases and, once you know that an employee has that disease, you put them into the group and make sure that you are following up with them at appropriate intervals and asking the right questions or performing the right activities, as with the example of diabetes we just discussed.[read point 4]Again, Chrissy will get into the ‘how’ of managing a surveillance program in more detail.
  • [don’t read slide, just read the following:]There is a lot of misunderstanding when it comes to medications and there is a place for the occupational health practitioner to get involved. Why? Pharmacists and primary care providers may provide some education but the patient may not remember everything or may not realize the importance of certain details, such as drug interactions and having prescribed tests done based on their medications. You can fill in gaps in the patient’s knowledge and emphasize the critical details they should know. As an example, if an employee is on statin for cholesterol management, they should know not to drink grapefruit juice [sue, can you explain what happens if they would??]. They may not also understand the importance of having liver function testing done, so you can drive home this message.
  • You can track how an employee is doing with their medications through a surveillance group. Once you know what medications they’re on, you can enroll them in an exposure group much like you would for chronic disease management or medical screening. Then you can set up appropriate times to recall them for coaching, and to monitor how they are doing with their medication, for example, are they still taking them, have they had any side effects, have they been for the appropriate testing, have any new medications been added.With the onset of high deductible health plans many patients cannot afford all of the medications and tests that they need so they are liable to skip the meds or tests in an effort to control their costs. By tracking their medication use in the occupational health clinic, you can discuss things like the use of generics and other ways to make sure that they get the treatment they need.
  • I see there being two key success factors in managing non-occupational health surveillance. The first factor is effective health coaching – the human side of things, and the second factor is a good occupational health data management system – the automated factor. By working to ensure both of these factors are effective, you can really support an successful health surveillance program.
  • [don’t read points on the slide, just read the following – feel free to ad-lib]The human relationship factor is critical in running a successful health surveillance program. At many companies these days, the employee will take theirHRA’s and then they get signed up for telephonic health coaching if they have risk factors that need to be addressed.In my experience the employees would much rather meet with a nurse that they know at the work site and review the HRA results than speak with a stranger on the phone.Face to face coaching has proved more effective than telephonic health coaching and the nurse already has a relationship with the employees so it makes sense to add health coaching related to the individual risk factors identified in the HRA. As we talked about earlier, the practitioner can be the employee’s champion and help them set goals. This is KEY to a good program that keeps the employee engaged and committed.
  • [don’t read slide, just read the following or ad-lib]There are many different programs you can use to manage data. What you currently have in place may or may not be working well. What I do want to stress is that, no matter what program you’re using, what’s important is that you’re thinking about the health surveillance, you’re thinking about health coaching and ways you can integrate it into your practice.Having said that, in my opinion as a clinic manager, a good software program provides a MUCH easier way to track surveillance. There are so many automation features that lend themselves well to the requirements of a surveillance program. For example, grouping everyone of the same age in a SEG and then tracking what their exposures are can be done in a spreadsheet, but as soon as you start adding in multiple exposures and clinical activities, and then adding other SEGs it becomes more complicated.Chrissy will elaborate on how software can help.
  • [read the points] OK, That’s the end of my presentation, I really hope that I helped you start thinking about ways you can incorporate health surveillance into your occupational health programs, or if you already have a program, how you can improve it or expand upon it. Thank you for your attention and feel free to contact me with any questions. I will now pass it over to Chrissy to talk more about how to set up an effective surveillance program and how to use surveillance to manage wellness initiatives.
  • Managing Employee Wellness using Occupational Health Surveillance

    3. 3.  Medgate Inc. 2013 PRESENTER – SUE NAYLOR • 30 years managing occupational health services • COHN & Family Nurse practitioner • 7 yrs developing / managing primary care services for an aluminum manufacturing company • Medical consultant for Medgate EHS software • Lectured on primary care in the workplace at the local and national levels
    4. 4.  Medgate Inc. 2013 WEBINAR DETAILS • This slide deck was adapted from a presentation given as part of a webinar in November, 2013  Medgate Inc. 2013 View the on-demand webinar now: “Promoting Employee Wellness in the Occupational Health Setting”
    5. 5.  Medgate Inc. 2013 JOEM STUDY – PUBLISHED JAN 2013 • Workplace health promotion programs have the potential to reduce avg worker health costs by . • Even more for older workers (9x!) "The potential savings from workplace wellness programs are…quite large and supportive of widespread interest by employers”– Dr. Dugas, author of study Source: 18 %
    6. 6.  Medgate Inc. 2013 OBESITY - 1990 • Increase in U.S. obesity from 1990 to 2010 Source
    7. 7.  Medgate Inc. 2013 OBESITY - 2000 Source
    8. 8.  Medgate Inc. 2013 Source OBESITY - 2010
    9. 9.  Medgate Inc. 2013 EXAMPLE: CARDIOVASCULAR DISEASE In the U.S… • Heart disease is the leading cause of death • Stroke is the 3rd leading cause of death • Together, accounted for over $500 billion in health care expenditures & related expenses in 2010 alone “Fortunately, they are also among the most preventable” Source:
    10. 10.  Medgate Inc. 2013 CARDIOVASCULAR DISEASE The risk of Americans developing and dying from cardiovascular disease would be substantially reduced if major improvements were made across the U.S. population in diet and physical activity, control of high blood pressure and cholesterol, smoking cessation, and appropriate aspirin use Source:
    11. 11.  Medgate Inc. 2013 WHY PROMOTE WELLNESS IN THE OCC HEALTH SETTING? • Lifestyle and external factors impact health as much if not more so than occupational factors • Employees often more comfortable with occ health than with their primary care provider • Perfect setting to get involved • You’re already conducting surveillance - why not expand to non-occ factors?
    12. 12.  Medgate Inc. 2013 Health status Health risks Chronic disease Health and Lifestyle behavior Ability to work AbsenteeismPerformance Profitability Productivity CYCLE OF HEALTH & PRODUCTIVITY Presenteeism
    13. 13.  Medgate Inc. 2013 OBJECTIVE OF HEALTH SURVEILLANCE IN THE OCC HEALTH SETTING • Cost Avoidance • Cost Management • Prevention Medicine • Benefit to Employees $ Treatment $ $ $ Early Detection $ $ $ $ $ Prevention Cost Savings
    14. 14.  Medgate Inc. 2013 ROLE OF OCC HEALTH Be the consultant Set Realistic Goals Celebrate successes
    16. 16.  Medgate Inc. 2013 CATEGORIES OF HEALTH SURVEILLANCE Medical Screening Management of Chronic Disease Medication Management
    17. 17.  Medgate Inc. 2013 Medical Screening
    18. 18.  Medgate Inc. 2013 MEDICAL SCREENING What to include? • Introduce standard medical screening tests, following guidelines from:
    19. 19.  Medgate Inc. 2013 MEDICAL SCREENING Link to guidelines American Cancer Society – found here American Heart Association – found here Diabetes Association – found here National Heart Blood Lung Institute – found here Any others you want to monitor
    20. 20.  Medgate Inc. 2013 MEDICAL SCREENING - SURVEILLANCE Ideas / Options: • Review screenings during scheduled occ. surveillance or bring employees in specifically • View Sue’s presentation for detailed suggestions on how to build a non-occupational health surveillance program
    21. 21.  Medgate Inc. 2013 © Medgate Inc. 2013 Management of Chronic Disease
    22. 22.  Medgate Inc. 2013 • Studies show that the smallest component of the workforce population has the highest claims because of chronic disease MANAGEMENT OF CHRONIC DISEASE
    23. 23.  Medgate Inc. 2013 • Set up surveillance group for Diabetes -> when employee visits, ask questions such as:  Educate, coach, set goals EXAMPLE – DIABETES MANAGEMENT Have you had an eye exam recently? Have you had a foot exam this year? Have you had your hemoglobin A1C checked in the last 6 months? Have you been taking your medication properly?
    24. 24.  Medgate Inc. 2013 CHRONIC DISEASE SURVEILLANCE • Build exposure groups to manage chronic diseases, ie: diabetes, cardiovascular, lung disease (asthma & emphysema), hypertension • Bring employees in at scheduled intervals or during occupational surveillance • Ask questions, perform related activities (per Diabetes example)
    25. 25.  Medgate Inc. 2013 Medication Management
    26. 26.  Medgate Inc. 2013 MEDICATION MANAGEMENT Role of Occupational Health • Supplement doctor / pharmacist education  Interactions / side effects  Required tests • Fill in gaps in knowledge:  ie: no grapefruit juice while on cholesterol meds  ie: importance of liver function testing • Drive home the message
    27. 27.  Medgate Inc. 2013 MEDICATION SURVEILLANCE GROUPS • Ask what medications they’re on • Enroll in exposure group • Recall at appropriate intervals • Perform relevant activities:  Coaching  Monitoring  side effects  related testing  new medications
    28. 28.  Medgate Inc. 2013 SUCCESS FACTORS Effective Health Coaching OH Data Management
    29. 29.  Medgate Inc. 2013 EFFECTIVE HEALTH COACHING • Human relationship is critical:  Health coaching is best face-to-face • Occupational health team is familiar and close by – and visits already scheduled • Patients more willing to discuss lifestyle management with someone they know • Remember it’s about goal setting and celebrating successes
    30. 30.  Medgate Inc. 2013 OCC HEALTH DATA MANAGEMENT • Can use various programs Spreadsheets, Access databases Homegrown systems Software • Software automation lends well to surveillance programs Add people to multiple exposure groups based on factors like age, gender, chronic factors  Automated scheduling & tracking of activities
    31. 31.  Medgate Inc. 2013 THE TRUE BENEFIT OF HEALTH SURVEILLANCE • Win-win for employee and company Company saves on absenteeism and disabilities and benefits from increased productivity Healthy employee is a happy, productive employee Employee feels better and in more control of their health Employee is healthierCompany saves
    32. 32.  Medgate Inc. 2013 • Learn about Medgate’s Medical Surveillance Recalls Module, part of our Occupational Health Suite